Chapter 24: Drugs for Neuromuscular Disorders: Myasthenia Gravis, Multiple Sclerosis, and Muscle Spasms Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 24: Drugs for Neuromuscular Disorders: Myasthenia Gravis, Multiple Sclerosis, and Muscle Spasms

Test Bank

MULTIPLE CHOICE

1. The client has been ordered to be treated with Edrophonium (Tension). The client who is most likely to be ordered this drug is the one who is suspected of having:

a.

multiple sclerosis.

b.

seizure disorders.

c.

parkinsonism.

d.

myasthenia gravis (MG).

ANS: D

This medication is used to diagnose myasthenia gravis; the patient receives the medication and is observed for an improvement in symptoms.

DIF: Cognitive Level: Analysis REF: p. 334

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A nurse is teaching a client who has been prescribed carisoprodol (Soma) for treatment of acute skeletal muscle spasms. Which instruction will the nurse include in the clients teaching plan?

a.

Take carisoprodol 1 hour before meals.

b.

Discontinue taking carisoprodol if experiencing drowsiness.

c.

Report episodes of rapid heart rate.

d.

Carisoprodol is usually taken for no longer than 7 days.

ANS: C

Owing to its sedative and side effects, carisoprodol (Soma) is usually taken no more than 3 weeks for treatment of acute spasms. To prevent gastrointestinal side effects, carisoprodol should be taken with food. Carisoprodol should not be abruptly discontinued, as it can cause rebound spasms. An adverse reaction to the medication can be indicated by tachycardia.

DIF: Cognitive Level: Application REF: p. 338

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A client with myasthenia gravis and his family are receiving instructions from the nurse. The nurse teaches the client that insufficient dosing of cholinesterase inhibitor may result in myasthenia crisis. The client is taught about which signs and symptoms of myasthenia crisis?

a.

Decreased muscle strength in the lower extremities

b.

Increased salivation and sweating

c.

Muscle weakness and increased salivation

d.

Muscle weakness; difficulty in breathing and swallowing

ANS: D

These are the major signs of myasthenia gravis, which may be undertreated with insufficient dosing of the medication. Increased salivation is related to cholinergic crisis.

DIF: Cognitive Level: Application REF: p. 335

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology

4. As part of a teaching session, a client with myasthenia gravis and her family are receiving instructions from the nurse. The nurse teaches the client that overdosing of cholinesterase inhibitor may result in cholinergic crisis. The client is taught about which signs and symptoms of cholinergic crisis?

a.

Decreased muscle strength and decreased salivation

b.

Increased salivation and sweating

c.

Muscle weakness and increased salivation

d.

Muscle spasticity and decreased salivation

ANS: C

These are the major signs of cholinergic crisis.

DIF: Cognitive Level: Application REF: p. 335

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A nurse is aware that when treating a client with cholinesterase inhibitors, it is imperative to have the antidote at the bedside. The nurse anticipates that the client will be ordered:

a.

epinephrine.

b.

norepinephrine.

c.

atropine.

d.

edrophonium chloride (Tensilon).

ANS: C

Atropine is the drug of choice for cholinergic crisis.

DIF: Cognitive Level: Application REF: p. 334

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The client is suspected of having multiple sclerosis. Which diagnostic test is the client most likely to be ordered?

a.

Computed tomography scan

b.

Magnetic resonance imaging (MRI)

c.

Protein in the cerebrospinal fluid

d.

Angiography

ANS: B

MRI is used to visualize the lesions.

DIF: Cognitive Level: Application REF: pp. 334-335

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology

7. A client is being evaluated for multiple sclerosis. The nurse may observe which symptoms of multiple sclerosis?

a.

Diplopia and weakness of the extremities

b.

Rigidity and tremors

c.

Masked facies and pill-rolling motion of the hand

d.

Memory loss and inability to concentrate

ANS: A

These are the major signs of multiple sclerosis.

DIF: Cognitive Level: Application REF: p. 339

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology

8. A client is diagnosed with multiple sclerosis and is to receive home care. The home care nurse is aware that some drugs are contraindicated with this disease, including:

a.

histamine2 blockers.

b.

calcium channel blockers.

c.

adrenocorticotropic hormone (ACTH).

d.

glucocorticoids.

ANS: A

Histamine2 blockers are contraindicated for the client who has multiple sclerosis.

DIF: Cognitive Level: Application REF: pp. 334-335

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A client is admitted to a nursing unit with an acute exacerbation of multiple sclerosis (MS). What drug, frequently used to decrease the inflammatory response, is used during an acute MS attack?

a.

Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others)

b.

Adrenocorticotropic hormone (ACTH)

c.

Biologic response modifiers, such as interferon beta-1b (Betaseron)

d.

Immunosuppressants, such as cyclophosphamide (Cytoxan)

ANS: B

ACTH can be used to treat an acute attack of MS.

DIF: Cognitive Level: Application REF: p. 336

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The client is prescribed Flexeril to relieve muscle spasms. The most important instruction that the nurse can give the client is to take the medication:

a.

on an empty stomach.

b.

with food or milk.

c.

upon arising.

d.

with water only.

ANS: B

Flexeril should be taken with food or milk.

DIF: Cognitive Level: Application REF: pp. 337-338

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client with chronic and progressive multiple sclerosis is ordered to receive cyclophosphamide (Cytoxan) to decrease symptoms. Based on this class of drug, which nursing diagnosis is a priority during this treatment?

a.

Risk for injury owing to seizure activity

b.

Risk for infection owing to immunosuppression

c.

Risk for constipation owing to neurotoxicity

d.

Risk for deficient fluid volume owing to diuresis

ANS: B

Cytoxan is an immunosuppressant and may cause life-threatening neutropenia.

DIF: Cognitive Level: Analysis REF: p. 336

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A child with cerebral palsy and spasticity is being treated with baclofen (Lioresal). Because drowsiness is a side effect, the nurse plans to administer the medication:

a.

during meals.

b.

a half-hour before physical therapy.

c.

during morning care.

d.

at bedtime.

ANS: D

The nurse correctly gives this medication at bedtime so that the drowsiness does not interfere with the clients routine.

DIF: Cognitive Level: Analysis REF: pp. 337-338

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A client with myasthenia gravis is noted to be salivating, tearing, and sweating. The client complains of muscle weakness. What would the nurse anticipate administering?

a.

Pyridostigmine bromide

b.

Neostigmine

c.

Edrophonium

d.

Atropine sulfate

ANS: D

These are the major signs of cholinergic crisis; the client would be treated with the antidote, atropine sulfate.

DIF: Cognitive Level: Application REF: p. 334

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A client is ordered to receive carisoprodol (Soma) for muscle relaxation. The client takes the medication for 3 weeks and then abruptly stops. The client is at increased risk for:

a.

excessive muscle relaxation.

b.

decreased range of motion.

c.

increased inflammation.

d.

rebound muscle spasms.

ANS: D

Rebound spasms may occur if carisoprodol (Soma) is stopped abruptly.

DIF: Cognitive Level: Comprehension REF: p. 339

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A client is ordered to receive adrenocorticotropic hormone (ACTH) for multiple sclerosis. Which nursing intervention would be most appropriate to protect this client from the side effects of this medication?

a.

Implement infection control measures.

b.

Administer antiemetics as needed.

c.

Give laxatives daily and as needed.

d.

Administer acetaminophen q4h.

ANS: A

ACTH may cause immunosuppression, which would warrant protective isolation.

DIF: Cognitive Level: Application REF: p. 336

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A client with myasthenia gravis demonstrates diplopia, ptosis, and dysphagia. The client is ordered to receive pyridostigmine bromide (Mestinon). What would indicate a positive outcome?

a.

Increase in the ability to sleep

b.

Decrease in muscle weakness

c.

Increase in hemiparesis

d.

Decrease in metabolic rate

ANS: B

A decrease in weakness would indicate a positive response.

DIF: Cognitive Level: Comprehension REF: p. 334

TOP: Nursing Process: Evaluation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The client has been ordered to be treated with Robaxin. The client calls the nurse in a panic and reports that his urine is black in color. The nurses response should be based on the knowledge that this is indicative of a(n) _______ to the medication.

a.

anaphylactic reaction

b.

adverse reaction

c.

subnormal response

d.

expected response

ANS: D

Robaxin can turn the clients urine green, brown, or black.

DIF: Cognitive Level: Application REF: pp. 337-338

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse receives report on a client with multiple sclerosis who is scheduled to be treated with Cytoxan. The nurse anticipates that the client will be:

a.

wheelchair enabled.

b.

experiencing motor weakness.

c.

complaining of fatigue.

d.

diagnosed with optic neuritis.

ANS: A

Cytoxan is used to treat a client who has progressive multiple sclerosis and who usually is wheelchair enabled.

DIF: Cognitive Level: Application REF: p. 336

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse recognizes that a dose of an AChE inhibitor was given 1 hour late. The nurse anticipates that the client will exhibit which symptom as a result of the late dosage?

a.

Excessive salivation

b.

Difficulty breathing

c.

Muscle weakness

d.

Bradycardia

ANS: C

All doses of AChE inhibitors should be administered on time, because late administration of the drug could result in muscle weakness.

DIF: Cognitive Level: Application REF: p. 334

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A client with myasthenia gravis is experiencing a myasthenic crisis. Which symptoms are associated with myasthenia gravis? (Select all that apply.)

a.

Weakness

b.

Fatigue

c.

Vomiting

d.

Sweating

e.

Drooling

f.

Tearing

ANS: A, B, E

Weakness and fatigue are prime symptoms of myasthenia gravis. The drooling is associated with the dysphagia.

DIF: Cognitive Level: Comprehension REF: p. 333

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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